Global prevalence of multimorbidity during pregnancy: a systematic review and meta-analysis

Multimorbidity, defined as having two or more coexisting physical or mental health conditions, increases the risk of complications and need of specialist care during pregnancy. In women of reproductive age, pregnancy represents a critical period during which multimorbidity may manifest or be exacerbated. Multimorbidity during pregnancy has been associated with a wide range of adverse maternal and neonatal outcomes. This systematic review aims to estimate the global and regional prevalences of multimorbidity during pregnancy, as well as to understand how multimorbidity is defined across studies.

We systematically searched four databases (Medline, Embase, CINAHL and Web of Science) for observational studies published from January 1, 2015, to September 26, 2025, without language or geographic restrictions. The protocol was registered in the PROSPERO database (CRD420251153876). We included peer-reviewed cross-sectional and cohort studies including ≥ 200 pregnant women, reporting the prevalence of multimorbidity. Data screening, extraction and quality assessment were conducted independently by two reviewers following PRISMA 2020 and Joanna Briggs Institute guidelines. Pooled prevalence was estimated via random-effects meta-analysis, and explored through predefined subgroup analyses.

The literature search retrieved 6,243 studies, and after title/abstract and full-text screening, 18 observational studies across eight countries were included in the review. The pooled prevalence of multimorbidity during pregnancy was 7.18% (95% CI: 3.31-14.89, I2 = 100.0%), with regional differences: 1.74% (95% CI: 0.46-6.37, I2 = 99.98%) in Asia, 9.07% (95% CI: 3.01-24.30, I2 = 100.0%) in North America, 11.17% (95% CI: 1.22-56.18, I2 = 99.94%) in Oceania and 12.64% (95% CI: 3.41-37.24, I2 = 99.99%) in Europe. However, the wide confidence intervals for Europe and Oceania warrant cautious interpretation of regional comparisons.

Multimorbidity during pregnancy is a significant and under-researched global health concern. The pooled prevalence of 7.18% reflects a synthesis of highly heterogeneous studies and should not be interpreted as a definitive estimate of the global burden. More standardized research, particularly in low- and middle-income countries, is needed to generate more representative prevalence estimates.